Purpose:   To develop methods to assess if the 2015-2020 National Strategy for the Prevention and Control of Obesity in South Africa had the desired outcomes.

Methods: A review team, consisting of six South African experts from fields related to Public Health, Nutrition, Physical Activity and Health Economics were commissioned by the national Department of health to review the 2015-2020 National Strategy for the Prevention and Control of Obesity in South Africa. The review team was supported by a National Advisory Team from national Departments related to Health, as well as country representatives from international health related agencies. They appointed a project coordinator and two international experts to provide technical and scientific support. The review team met regularly with the advisory and support teams, and provided feedback on the review process. A scoping review of international best practices implemented in national obesity management strategies was conducted. Potential stakeholder groups were identified based on the scoping review and the review of responsible agents proposed in the 2015-2020 strategy. A theory of change and methods for the review were developed to state what the strategy set out to achieve, the vision and the mission and how the objectives could be achieved.

Results: The research questions were if the National Strategy for the Prevention and Control of Obesity in South Africa achieved its goals and objectives, how these can be strengthened and what needs to be changed. Eleven stakeholder groups were identified, including different levels of implementers from government, academic and research institutions, professional societies, medical aid schemes, health professionals, community influencers, local food outlet managers and people living with obesity. In-depth online questionnaires with structured responses and open questions, and a focus group discussion guide were developed to explore stakeholder perceptions of the drivers and outcomes of the strategy. Questions for each group of stakeholders were formulated by the review team and international experts based on the Obesity Strategy (2015-2020), according to the proposed roles of each group of stakeholders.

Conclusions: Methods to review the strategy focussed on the advancement of behavioural nutrition and physical activity of South Africans through broad stakeholder engagement.

Purpose:   To assess if the national strategy for the prevention and control of obesity in South Africa (2015-2020) had the desired outcomes.

The research questions were to establish if the national strategy for the prevention and control of obesity in South Africa (2015-2020) achieved its goals and objectives, how these can be strengthened and what needs to be changed.

Methods: A purposeful sampling strategy was adopted to capture a breadth of perceptions from stakeholders involved in the implementation of the 2015-2020 strategy. Eleven groups of stakeholders were identified based on information from a desktop review of international best practices implemented in national obesity strategies and stakeholder groups involved in the 2015-2020 strategy. In-depth, semi-structured, one-to-one interviews, online questionnaires with structured and open questions, and focus group discussions (FGDs) were used to explore stakeholder perceptions of the outcomes of the implementation of the strategy. Quantitative responses from the questionnaires were analysed as frequencies, enabling identification of the dominant responses, as well as minority perceptions.  Qualitative responses to open ended questions were analysed using thematic analysis. The FGD data and 384 questionnaire responses were synthesised in relation to the research questions.

Results:   Few successes and several challenges related to the implementation of the strategy were identified by stakeholders. Successes included implementation of sugar tax on sugar-sweetened beverages and early child health campaigns. Challenges were used to develop goals and objectives that will be used to update the next strategy. Stakeholders recommended that the strategy must be based on evidence-based research and that responsibility to achieve the goals of the NSPCOSA should be allocated to specific agents. Stakeholders requested to be involved during initial planning of the revised strategy.  Recommendations included to enforce front-of-pack labelling of foods, improve education and communication, and regulate advertising of unhealthy foods and drinks to children. A monitoring and evaluation framework is recommended to improve implementation and monitor progress. 

Conclusions:  Responses shared by the stakeholders indicated few successes and highlighted challenges that hampered implementation of actions related to behavioural nutrition and physical activity in the 2015-2020 National Strategy for the Prevention and Control of Obesity in South Africa.

Purpose:   To review if the National Strategy for the Prevention and Control of Obesity in South Africa (2015-2020) based on stakeholder responses and a scoping review of international best practices is fit for the purpose.

The research questions were how the National Strategy for the Prevention and Control of Obesity in South Africa (2015-2020) can be revised based on evidence from a scoping review and stakeholder responses.

Methods: Responses from a purposeful sample of stakeholders involved in the implementation of the 2015-2020 strategy and evidence from a scoping review of international best practices implemented in national obesity strategies were analysed. Dominant responses, as well as minority perceptions were identified.  Qualitative responses to open ended questions were analysed using thematic analysis. The focus group discussions data and 384 questionnaire responses were synthesised in relation to the research questions. The scoping review identified international best practices in terms of national obesity management strategies. Stakeholders were involved during initial planning in workshops and interviews, to validate responses and allocate responsibility to achieve the goals of the revised strategy.

Results:   The success factors identified were included as ongoing actions in the revised strategy. The themes derived from challenges were used to develop goals and objectives for the updated new strategy. Evidence from the scoping review indicated that front-of-pack labelling of foods is useful to identify healthy food and unhealthy options and to communicate nutrition information to consumers. Training of health care workers, banning sale of unhealthy foods and sugar-sweetened beverages in schools, or product reformulation to improve the nutrient content of ultra-processed foods were also successful interventions. Recommendations to enforce front-of-pack labelling, improve education and communication, to regulate advertising of unhealthy foods and drinks to children, as well as improved access to safe environments for physical activity were included. A monitoring and evaluation framework was proposed to improve implementation and monitor progress. 

Conclusions:  Experiences shared by the stakeholders and evidence from a scoping review were used to revise the Obesity Strategy for the Prevention and Control of Obesity South Africa and to develop improved implementation of actions related to behavioural nutrition and physical activity.